13 Dec Clean Claims Are a Team Effort

Claim denials can cost medical practices tens of thousands of dollars a year. According to MGMA, the average cost to rework a denied claim is $25, which adds up quickly.

Clean claims, or those that are submitted to insurance companies without errors or missing documentation and are paid in a timely manner, are very much a team effort.

Here’s three things that front desk staff, clinicians, coding, and billing staff all need to be mindful of to keep things moving smoothly:

Registration Your front desk staff needs to ask for and verify proof of insurance coverage from every patient. Ensuring that insurance information is current and entered into your practice management or EHR system is critical to timely revenue flow. These staff members are your first line of defense for your revenue cycle- make sure they understand that their work is critical to ensuring the health of your practice.

Diagnosis Codes ICD-10 is complex, and the potential for error can be high if you’re not careful. Diagnosis code mismatch or outdated codes are common reasons for claim denials. A diagnosis code mismatch is when the code reported doesn’t make sense when combined with the CPT code with which it’s linked. For example, if you’re reporting a CPT for a simple integumentary repair, accidentally linking the diagnosis code for pharyngitis wouldn’t make sense and would trigger a denial.

Timely Filing Your billing staff is key when it comes to staying on top of filing deadlines. Each payor has different criteria for the required timeframe for claim submission, which can be as short as 90 days after the date of service. There’s no room for procrastination here!

Nobody likes having to work through claims that are denied, and it unnecessarily increases the time it takes for you to get paid for your work. Great communication with patients and with insurers, well-trained coding professionals and front desk staff as well as thorough medical billing processes can all help you prevent claim denials and the headaches that go along with them.

As you evaluate your practice’s performance for this year, remember that our team of revenue cycle experts is always available to help you address the challenges you may face.

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